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Family therapists are well equipped to work in healthcare settings across clinical, training/supervision, management/policy, and scholarship efforts. This blog post is the first in a series (of four) that highlights core competencies across these respective foci. It begins by describing how field leaders worked with AAMFT to identify said competencies, and then highlights those specific to clinical efforts. These efforts are anchored within systems-, biopsychosocial/spiritual-, collaboration-, leadership-, ethics-, and diversity- domains.
Core Clinical Competencies for Family Therapists Working in Healthcare Settings
In 2013, a team of field leaders in Medical Family Therapy came together to develop competencies for family therapists working in healthcare settings. They initiated these efforts in response to the increasing numbers of therapists being sought-out for and placed within such settings, alongside a recognition that clear guidelines regarding knowledge, skills, and abilities for effective engagement in such placements were not yet available. Over the next four years, this team worked across small- and large- group formats to identify key domain areas, associated skillsets, and target indicators relevant to this work. For a thorough description of the steps encompassed in this effort, see American Association for Marriage and Family Therapy [AAMFT] (2018).
Core competencies for family therapists working in healthcare settings are situated in four principal areas: (a) clinical skills; (b) training and supervision; (c) healthcare management and policy; and (d) scholarship. Each of these domains are further anchored in six domains (systems, biopsychosocial/spiritual, collaboration, leadership, ethics, and diversity).
The following is a summary of core competencies related to clinical skills; ensuing blogs on this website will highlight competencies in training and supervision, healthcare management and policy, and scholarship.
Clinical Competencies
As clinicians who are excited about our own work in healthcare contexts, we have been energized by the opportunity to present at AAMFT conferences and publish on our experiences in a variety of healthcare settings. Over the years, a number of family therapists would ask what they need to know in order to work in a healthcare context. First and foremost, we believe that clinical competencies for family therapists in healthcare settings must be grounded in the AAMFT’s Code of Ethics (2015) and MFT Core Competencies (2004). A team of family therapists then united to offer additional competencies uniquely constructed for family therapists in healthcare settings. Leaders in the field agreed that there was a need for additional specialized training and skills in order to maximize employment in and collaboration with healthcare settings and systems. Below is a sample of the clinical competencies via the six domains:
Clinical competencies related to general systems. Family therapists working in healthcare settings must advance clinical efforts in a manner that recognizes and honors multi-level and multi-directional influences between family members (e.g., patients, spouses, parents, children), between healthcare providers (e.g., behavioral, biomedical, pastoral), and between families and healthcare providers (as active participants in team-based care). They are thereby able to engage patients and families in support regarding, processing of, coping with, and effectively managing health crises/conditions/challenges, while at the same time facilitating valuable communication and collaboration between multiple providers involved in their care.
Family therapists in healthcare contexts balance conversations across the continuum from illness to well-being, deficits to resilience, strengths to weaknesses, hope to despair, and acceptance to agency toward change. They maintain competence in explaining literature and implementing practice through best- and systemic- interventions across multiple fields (e.g., Family Therapy, Medicine, Nursing), and through a variety of theories and models as they interface with systemic health concerns (e.g., motivational interviewing with patients who wish to stop smoking, structural family therapy + psychoeducation for adolescents living with diabetes).
Clinical competencies related to biopsychosocial-spiritual (BPSS) systems. Family therapists in healthcare settings consistently work to advance clinical care with clear knowledge regarding the biological components of – and biomedical interventions for – diseases that are customary to the care sites within which they are positioned and how those components interface with psychosocial and spiritual health and beliefs. For example, those working in endocrinology are familiar with metabolic processes, disease management strategies, and medications core to diabetes care as they interface with health behaviors and spiritual practices; those working in oncology are similarly conversant with physiological processes, testing sequences, and care-strategies common in cancer care – particularly as they intersect with relational decision making and mental health comorbidities. They are up-to-date in psychopharmacology (e.g., medication classes, common uses, common side effects), especially regarding drugs most frequently prescribed in their sites. They communicate in manners that demonstrate healthcare literacy across multiple disciplines (e.g., medical- and psychological/psychiatric- terminology, disease- and/or diagnosis- specific nomenclatures), and regularly articulate the manners in which multiple BPSS dimensions interact with each other in the present, across the lifespan, and with consideration of cultural / spiritual beliefs and practices.
Clinical competencies related to collaboration. Connecting the multiple and complex-overlapping dots of systems- and BPSS- sensitive care, family therapists in healthcare settings work hard to employ evidence-based models that promote interdisciplinary collaboration and relational care. They do this in a manner driven by respectful working alliances with patients, families, and other involved professionals working together en route to shared treatment goals. Family therapists in healthcare contexts must know how to navigate collaborative relationships through careful, purposeful, and flexible attention to collaborative efforts that span across workflow time (before, during, and after care encounters) and mediums (verbal, written, electronic, etc.).
Clinical competencies related to leadership. Family therapists in healthcare settings work hard to create and/or promote evidence-based models of integrated behavioral health care in collaboration with patients, families, healthcare team members, supervisees, administrators, community partners, researchers, and policy-makers. They do this through providing education about, modeling, and/or advancing clinical practices that maximize care outcomes, cost efficiency, and/or training and mentoring development. Given the systemic and BPSS training of family therapists in health care contexts, it is not uncommon to be asked to serve in leadership roles such as behavioral health director. Many also secure advanced credentialing and/or certification in leadership and supervision, which further-establishes their integrity as advocates for (and others’ receptivity of) the content and practices that they espouse.
Clinical competencies related to ethics. Family therapists in healthcare settings must demonstrate adherence to ethical practice in all that they do. This is a complex undertaking, however, because it requires practicing with informed knowledge regarding one’s own and other providers’ overlapping and distinct disciplinary guidelines that regulate foci like scope of practice, confidentiality, and billing – alongside appropriate and purposeful problem-solving vis-à-vis commonplace ethical dilemmas. Combined with these baseline knowledge areas and skillsets, these therapists must function in a manner that is consistently receptive to (and seeking of) input and support from colleagues, supervisors, site administrators, and legal counsel.
Clinical competencies related to diversity. Family therapists in healthcare settings must show awareness of, curiosity about, and respect for different biopsychosocial/spiritual beliefs, practices, and traditions across the intersection of social locations (e.g., ability, age, sexual orientation, gender identity). Furthermore, family therapists must be informed of historical marginalization and be aware of how to honor preferred treatment options for diverse populations. These understandings enable unique and/or sacredly-held viewpoints and customs to be effectively carried out, accommodated, and/or integrated into care provision (inside- and outside- of the clinic/hospital). These therapists also regard “diversity” as encompassing attention to social locations, and they work to incorporate sensitivity to these foci across the purposeful design, implementation, and evaluation of treatment plans. They do this with explicit recognition of their own personal biases and beliefs, and openly seek support/training/supervision to process and/or improve their efforts as indicated.
Conclusion
Core clinical competencies for family therapists working in healthcare settings cut across systems-, biopsychosocial/spiritual-, collaboration-, leadership-, ethics-, and diversity- domains. Crossing primary (e.g., family medicine, pediatrics), secondary (e.g., OBGYN, emergency medicine), tertiary (e.g., hospice care, alcohol and drug treatment), and other care environments (e.g., employee assistance programs, military care systems), these skillsets are essential for the effective integration of family therapists into medically-oriented treatment and interdisciplinary care teams.
Note: As outlined in this blog’s introductory text, ensuing installments will highlight other core competencies for family therapists in healthcare settings. These will include attention toward training and supervision, healthcare management and policy, and scholarship.
References
American Association for Marriage and Family Therapy (2018). Competencies for family therapists working in healthcare care settings. Retrieved from www.aamft.org/healthcare
American Association for Marriage and Family Therapy (2015). Code of ethics. Retrieved from http://www.aamft.org/iMIS15/AAMFT/Content/Legal_Ethics/Code_of_Ethics.aspx
American Association for Marriage and Family Therapy (2004). Marriage and family therapy core competencies.
Authors
Tai Mendenhall, Ph.D., LMFT
Angela Lamson, Ph.D., LMFT
Jennifer Hodgson, Ph.D., LMFT
Lisa Tyndall, Ph.D., LMFT
Jackie Williams-Reade, Ph.D., LMFT
Stephanie Trudeau, Ph.D.